Rule to Ease Consumer Understanding of Health Insurance Policies

Six federal agencies have issued a final rule requiring insurers to provide to consumers at the time of enrollment a plain-English summary of benefits and coverage, and a uniform glossary of terms.

The rule is mandated under the Affordable Care Act. The agencies—the Internal Revenue Service, Department of Treasury, Employee Benefits Security Administration, Department of Labor, Centers for Medicare and Medicaid Services, and Department of Health and Human Services (HHS)—also have issued a notice outlying templates, instructions and related materials, and guidance for compliance.

Insurers are compelled to offer a summary of care “that accurately describes the benefits and coverage under the applicable plan or coverage,” according to the rule. The federal agencies worked with the National Association of Insurance Commissioners and consumer advocacy groups on the language.

According to a statement from HHS, the summary “will help consumers better understand the coverage they have and allow them to easily compare different coverage options. It will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions.”

The final rule and notice are available now and will be published February 14 in the Federal Register.